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Health

Should you trust a medical journal?

Adam Wagstaff's picture

While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.

Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.

Measuring universal health coverage – plus ça change?

Adam Wagstaff's picture

In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.

Feeding the poor: shifting food within and across borders

Mohini Datt's picture

While the world’s population doubled in the last fifty years, global food production trebled – especially in the staple grains that form the mainstay of the poor man’s diet.  Yet, over a billion people in the world still go hungry - why?

As the World Bank’s Global Monitoring Report of 2012 shows, it is not that the world as a whole lacks rice, wheat or maize, but produce from food abundant areas does not always make it to food deficit ones – i.e. it is not so much the availability of food that matters as access to it.
Movement of food within a country or across its borders remains hampered by dismal infrastructure and inefficient regulations, and shackled to the dictates of political economy.   Yet, trading food can feed the poor at lower costs and help countries weather shocks to local production.

Humanizing health systems

Adam Wagstaff's picture

In 1960, I wouldn’t have been writing this blog post. For a start I was just a baby at the time. Second, we were several decades away from 1994 when Justin Hall – then a student at Swarthmore – would sit down and tap out the world’s first blog. Most importantly of all, though, according to Google’s ngram viewer, people didn’t write about health systems much in 1960 (see chart). Usage of the term in books took off only in the mid 1960s, waned in the 1980s, and then started rising again in the 1990s. This doesn’t look like a statistical artifact. Usage of the term “Nobel prize” has stayed relatively constant over the period, and while the term “health economics” has also trended upwards, the growth has been much slower. So “health systems” is a fairly new term – and it’s on the rise.

Click on this image to see a larger version.

Not everyone thinks that’s a good thing.

Do Informed Citizens Receive More, or Pay More?

Philip Keefer's picture

One widely-accepted political economy research finding is that informed citizens receive greater benefits from government transfer programs. The evidence for the impact of information comes from particular contexts—disaster relief in India and welfare payments in the USA during the Great Depression.  Do other contexts yield similar results?  New research on the distribution of anti-malaria bed nets in Benin suggests:  “No.”  Instead, local health officials charged more informed households for bed nets that they could have given them for free.

The Benin context differs in three ways.  First, the policy is not the distribution of cash, but of health benefits.  Households’ access to information then influences not only their knowledge of government programs to distribute such benefits, but also the value they place on them. 

Second, the political context also differs.  In younger democracies, like Benin’s, citizens are more likely to confront additional obstacles, besides a lack of information, in their efforts to extract promised benefits from government.

Are the Knowledge Bank’s assets actually being used? The case of the World Bank’s Human Development sector

Adam Wagstaff's picture

According to its first-ever Knowledge Report, published earlier this year, the World Bank spends over $600 million a year on “core knowledge services” – research, economic and sector work, technical assistance, “knowledge management”, training, and the like. Yet as the authors of report concede, precious little is known about the impact of this spending.

In a post on this blog last year, I reported on some work that Martin Ravallion and I did on a subset of the Bank’s knowledge portfolio – formal publications. We found the publications portfolio is larger than typically thought: the Bank’s Documents and Reports (D&R) database excludes the vast majority of journal articles authored by Bank staff, and there are as many of these as there are books and other formal publications published by the Bank. We also tried to look at the impact of the Bank’s publications on development thinking, which we measured using citations in Google Scholar. We found that, despite a view by some that the Bank is more a proselytizer than a producer of new knowledge, a lot of Bank publications do get cited a lot, suggesting that these publications contain new knowledge that’s considered useful by others.

Food Prices, Nutrition and the Millennium Development Goals

Jos Verbeek's picture

How are communities around the world coping with the higher and more volatile food prices? What is the impact on poverty, or on nutritional outcomes? And, how should policymakers respond to such price spikes that can eat away at already-tight budgetary resources?

These are only some of the questions that a key World Bank-IMF report is delving into as it provides an annual assessment on progress towards the Millennium Development Goals (MDGs) as well as the challenges which developing countries face in achieving them. 

Seasonal Hunger: A Forgotten Reality

Shahid Khandker's picture

Harvesting crops. Bangladesh. Photo: Thomas Sennett / World BankThe seasonality of poverty and food deprivation is a common feature of rural livelihood in Bangladesh, but it is more marked in the northwest region of Rangpur.  The recently launched policy interventions in the region provide a test case of what works and what does not in combating seasonal hunger.

Key messages
The analysis of Bangladesh’s experience with seasonal hunger vis-à-vis year-round poverty shows a clear distinction between what is observed and what is excluded from placement and evaluation of poverty-mitigation policies, based on official poverty statistics. The key recommendations from this analysis are as follows: 

Health System Innovation in India Part III

Adam Wagstaff's picture

Taking high-quality affordable primary care to the rural poor with the help of handheld computers, telemedicine, and P4P.

In our first post in this series, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In our last post, we outlined the Aarogyasri scheme—a novel government-sponsored health insurance program in the state of Andhra Pradesh that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care. In this post, we discuss an innovative private-sector approach to delivering and financing primary health care in rural Andhra Pradesh.

Health System Innovation in India Part II: Aarogyasri

Adam Wagstaff's picture

More than health insurance for the poor

In our last post, we showed how illness in India causes financial hardship and leaves Indians—especially poor ones—with limited access to affordable good-quality health care that can actually make them better. In this post, we outline a novel government-sponsored health insurance program in the state of Andhra Pradesh (AP)—a program that has the potential not just to reduce financial impoverishment but also raise quality standards in hospital care.

a) “Actors”, and their rights and responsibilities

Initiated by the then chief minister of AP, the medical doctor YSR Reddy, the Rajiv Aarogyasri scheme started in 2007 and is targeted at the below-poverty line (BPL) population. The scheme focuses on life-saving procedures that aren’t covered elsewhere in India’s patchwork of health programs, for which treatment protocols are available, and for which specialist doctors and equipment are required. Currently 938 tertiary care procedures are covered. The scheme revolves around five key “actors”, one unique to Aarogyasri and all with interesting rights and responsibilities.

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